A propensity score matching study on robot-assisted radical cystectomy for older patients: comparison of intracorporeal ileal conduit and cutaneous ureterostomy

Abstract

Background Robot-assisted radical cystectomy (RARC) and intracorporeal urinary diversion are less invasive than conventional procedures. However, for older patients, cutaneous ureterostomy (CUS) may be preferred because urinary diversion using the intestine has a high incidence of perioperative complications and is highly invasive. The purpose of this study was to demonstrate the safety and efficacy of intracorporeal ileal conduit (ICIC) compared with CUS in patients aged 75 years or older who underwent RARC. Methods From October 2014 to December 2021, 82 patients aged 75 years or older who underwent RARC at Tokushima University Hospital, Tokushima Prefectural Central Hospital, or Ehime Prefectural Central Hospital were retrospectively reviewed. Of these, 52 and 25 patients who underwent ICIC and CUS, respectively, were included. After adjusting the patients’ characteristics using propensity score-matching, surgical results and prognoses were retrospectively compared. The propensity score was based on age, Eastern Cooperative Oncology Group Performance Status Scale (ECOG-PS), American Society of Anesthesiologists physical status classification (ASA-PS), clinical tumor stage, and neoadjuvant chemotherapy. Results The median age was lower in the ICIC group compared with the CUS group, and the proportion of high-risk cases (ECOG-PS ≥ 2 or ASA-PS ≥ 3) did not differ. The median operation time was longer in the ICIC group, and estimated blood loss was higher, compared with the CUS group. There were no significant differences in the incidence of complications within the first 30 postoperative days, incidence of complications 30–90 days after surgery, 2-year overall survival, 2-year cancer-specific survival, and 2-year recurrence-free survival. The stent-free rate was significantly lower in the CUS group than that in the ICIC group. Conclusion In older patients, the ICIC group showed non-inferior surgical and oncological outcomes compared with the CUS group. Urinary diversion following RARC in older patients should be carefully selected by considering not only the age but also the general condition (including comorbidities) of the patient.

Lymph node dissection during radical cystectomy for bladder cancer: A two‐center comparative study of robotic versus open surgery

“…In Japan, RARC has spread rapidly since it became covered by health insurance in April 2018. 1 Two randomized controlled trials have compared LND between RARC and ORC. The first was performed by Parekh et al in 2018.…”

“…RARC using the da Vinci Surgical System (Intuitive Surgical) was first reported in 2003 by Menon et al 5 Because of the high flexibility and sophisticated operability of the instruments, this system is effective for radical cystectomy, which requires high surgical skill. In Japan, RARC has spread rapidly since it became covered by health insurance in April 2018 1 …”

“…In Japan, RARC has spread rapidly since it became covered by health insurance in 2018. 1 This study was performed to evaluate the safety and efficacy of lymph node dissection (LND) during RARC. We compared the perioperative and oncological outcomes of RARC compared with those of open radical cystectomy (ORC).…”

“…Because of the high flexibility and sophisticated operability of its instruments, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is an effective device for robot‐assisted radical cystectomy (RARC), which requires a high level of surgical skill. In Japan, RARC has spread rapidly since it became covered by health insurance in 2018 1 . This study was performed to evaluate the safety and efficacy of lymph node dissection (LND) during RARC.…”

Complete retroperitoneal cutaneous ureterostomy with robot‐assisted radical cystectomy

“…Older patients, particularly those in a hypoalimentation state, may have better outcomes with CU 1,2 . CU has shorter operation times and is less invasive for the intestinal tract 3 . However, owing to the anatomical location of the ureter along the abdominal cavity after RARC, there are still risks of complications, including ileus, parastomal hernia 4,5 .…”